| NPI | 1730762899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS022991) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT020707) |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2025-06-16 |